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OPHTHALMIC IMAGE
Year : 2021  |  Volume : 1  |  Issue : 3  |  Page : 461

Active vitreous hemorrhage on real-time video-angiography


1 Vitreoretinal Diseases and Surgery, Istanbul Retina Institute, Istanbul, Turkey
2 Vitreoretinal Diseases and Surgery, Biruni University School of Medicine, Istanbul, Turkey

Date of Web Publication02-Jul-2021

Correspondence Address:
Murat Karacorlu
Vitreoretinal Diseases and Surgery, Istanbul RETINA Enstitüsü, Hakki Yeten Cad. Unimed Center No: 19/7, Fulya – Sisli, Istanbul - 34349
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2897_20

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How to cite this article:
Hocaoglu M, Muslubas IS, Ersoz M G, Arf S, Karacorlu M. Active vitreous hemorrhage on real-time video-angiography. Indian J Ophthalmol Case Rep 2021;1:461

How to cite this URL:
Hocaoglu M, Muslubas IS, Ersoz M G, Arf S, Karacorlu M. Active vitreous hemorrhage on real-time video-angiography. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Jul 28];1:461. Available from: https://www.ijoreports.in/text.asp?2021/1/3/461/320023



A 63-year-old male patient with a history of systemic hypertension and coronary artery disease presented for an annual ophthalmic examination. On examination, visual acuity was 20/20 OU and intraocular pressure was 14 mm Hg OU. The anterior segment was unremarkable. Fundus examination revealed bilateral grade I–II hypertensive retinopathy. Additionally, arteriovenous nicking close to the optic disc inferiorly with diffuse hemorrhages in the inferorotemporal quadrant consistent with inferior branch retinal vein occlusion were observed in the left eye. Both video and still-frame fluorescein angiography images were obtained using the Spectralis HRA + OCT imaging platform (Heidelberg Engineering, Heidelberg, Germany). Fluorescein angiography of the left eye showed delayed filling and tortuosity of the occluded retinal vein, and blocked fluorescence due to retinal hemorrhages [Figure 1]a. About four minutes following the injection of fluorescein dye, an extravasation of blood from the retinal area adjacent to temporal vascular arcade into the vitreous cavity was observed [Figure 1]b and [Figure 1]c. Shortly thereafter, the bleeding stopped spontaneously [Figure 1]d. The cross-sectional retinal optical coherence tomography image showed thickened inner retina temporal to the fovea with superficial hemorrhages which produce an underlying shadow effect [Figure 1]e.
Figure 1: (a) Fluorescein angiography demonstrates arteriovenous nicking inferior to the optic disc, tortuosity of the occluded retinal vein and blocked fluorescence due to superficial hemorrhages. (b) About four minutes after the injection of fluorescein an active bleeding from the retinal area adjacent to temporal vascular arcade is observed (c) The blood is leaking down to the vitreous space. (d) Soon afterwards the bleeding spontaneously resolves. (e) The cross-sectional retinal optical coherence tomography image showed thickened inner retina temporal to the fovea with superficial hemorrhages which produce an underlying shadow effect

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Fluorescein angiography is a valuable diagnostic modality in cases of branch retinal vein occlusion. However, documentation of active hemorrhage during fluorescein angiography is a remarkably uncommon entity and only a few cases have been reported in the literature.[1],[2],[3],[4],[5] More importantly we provide a dynamic fluorescein angiography video recording [Video, Supplemental Digital Content 1]. A possible explanation that has been proposed for this event could be a valsalva retinopathy like phenomenon when a sudden increase in intrathoracic or intraabdominal pressure leads to spontaneous rupture of superficial retinal vessels.[2],[3],[4],[5]

Declaration of patient consent




The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Territo JG, Rose SJ, Lindahl KJ. Spontaneous rupture of a macroaneurysm documented in real time during fluorescein angiography. Arch Ophthalmol 2000;118:144-5.  Back to cited text no. 1
    
2.
Levy J, Rosenthal G, Klemperer I, Schneck M, Lifshitz T. Active spontaneous bleeding from optic disc neovascularization during fluorescein angiography. Arch Ophthalmol 2002;120:1766.  Back to cited text no. 2
    
3.
Tewari R, Kumar V, Chandra P, Kumar A. Documentation of active bleed from retinal neovascularization during fluorescein angiography. Indian J Ophthalmol 2018;66:297-8.  Back to cited text no. 3
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4.
Kassoff A, Catalano RA, Mehu M. Vitreous hemorrhage and the valsalva maneuver in proliferative diabetic retinopathy. Retina 1988;8:174-6.  Back to cited text no. 4
    
5.
Jones WL. Valsalva maneuver induced vitreous hemorrhage. J Am Optom Assoc 1995;66:301-4.  Back to cited text no. 5
    


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